Bureau for Public Health Story Archives - West Virginia Public Broadcasting

Lawmakers Grow Impatient With Lack Of Health Action

Lawmakers questioned West Virginia’s State Health Officer Matthew Christiansen during a meeting of the Joint Committee on Health about the agency’s lack of action.

Commissioner of the Department of Health and Human Resources’ Bureau for Public Health and West Virginia State Health Office, Matthew Christiansen, presented a state health plan to the West Virginia Legislature’s Joint Committee on Health.

However, lawmakers questioned the plan’s similarities to past years and the lack of specific goals.

Del. Mike Pushkin, D-Kanawha, thanked Christiansen for his report but asked if anything the legislature has done has helped improve the state’s health outcomes.

“We’ve been here long enough to see similar reports from other state health officials,” Pushkin said. “Have we seen any movement? Are we still at the bottom of every list or at the top of every rung list when it comes to poor public health outcomes? Has anything we’ve done here, moved the needle at all?”

Christiansen answered that there have been improvements in insurance access and accessibility to health care.

“Health care services and insurance coverage is one that we are consistently in the top 10 or so in the nation,” Christiansen said. “And so we do a good job at that; however, we still struggle with transportation issues, as you and I have discussed in the past, and accessibility of that health care access.”

Pushkin responded that the legislature expanded Medicaid for West Virginia residents years ago.

Starting Jan. 1, 2014, West Virginia expanded Medicaid under the Affordable Care Act. Under the expanded eligibility guidelines, adults aged 19 to 64 are eligible for Medicaid with a household income up to 138 percent of the poverty level.

For a single adult in 2023, that amounts to $20,120 in total annual income.

“I guess what I’m getting at, we’ve heard for years about the determinants of poor public health outcomes, whether it was in regards to children with adverse childhood experiences, or with other socio-economic factors that leads to these outcomes,” Pushkin said. “There have been a lot of plans and I’d hoped that this body, that the legislature is able to actually address it at some point, or we’re going to continue to be at the bottom of every list that we don’t want to be on.”

Del. Amy Summers, R-Taylor, said she and other members of the joint committee on health grew frustrated at the inaction.

“Where I think we reach frustration is that we never get past the planning stage. And we want to be where we get three to six measurable goals, and what will they be? And how are we going to measure them, and okay, we achieve these things, and let’s move to the next thing,” Summers said. “But we never seem to get to that point. And I think that’s just all of our desire, yours as well, is to change some things.”

Christiansen said the current state health plan will be the one implemented, but it will take time.

“This will be that,” Christiansen said. “The State Health Improvement Plan will be that plan that will have a clear set of priorities, a big part of our assessment and survey processes around that stakeholder engagement piece to make sure that we’re bringing other people to the table, acknowledging that we again can’t do those things alone as the Bureau for Public Health but that we need all of our other public health and health care partners at the table.”

Troubled Teens Sent Out-Of-State, CPS Shortages Falling But Still Present

Legislators learned Monday there are more than 300 teens in out-of-state facilities because there’s no place to house them in West Virginia and there are approximately 83 vacancies in the state’s Child and Adult Protective Services

Legislators learned Monday there are more than 300 teens in out-of-state facilities because there’s no place to house them in West Virginia, and there are approximately 83 vacancies in the state’s Child and Adult Protective Services.

Facilities For Violent Teens

The West Virginia Legislature’s Joint Committee on the Judiciary heard testimony Monday from Judge Steve Redding from the 23rd Judicial Court in Berkeley County. He told the committee one of the biggest problems he faces as a judge is there is no in-state facility to handle violent or out of control teens in West Virginia.

“This creates an untenable situation where it’s too dangerous to leave the child in the community, but no in-state facility will accept them,” he said. “This creates an unnecessary delay in obtaining permanency for the children in our care. And studies have demonstrated that the longer it takes to obtain permanent permanency, the more difficult it becomes for that child to become a stable, functioning adult.”

Redding explained that sending children to out-of-state facilities is the last and final option.

“The court in almost every case begins by ordering wraparound community services in the home,” he said. “If that’s unsuccessful, and the child continues to commit offenses, use drugs or otherwise places his or herself and others in danger, we look to the least restrictive in-state placement.”

He explained that some children exhibit behaviors that are so out of control and dangerous that no in-state facility will accept them. He said the courts waste time requiring the department to exhaust all in-state possibilities prior to ordering that out-of-state referrals be made when they already know there are no in-state providers that can accept these children.

“These are typically children that are violent, or committed sexual offenses,” Redding said. “For a child 14 years or older, who is competent, we have the ability to place that child in detention until a bed is available in order to keep the child’s family and the community safe. For those children under the age of 14, or those 14 and over that are intellectually delayed, on the spectrum or are suffering from significant mental health issues, they are deemed incompetent to stand trial.”

Redding said the law prohibits the court from placing those youth in detention.

Jeffrey Pack, the commissioner for the Bureau for Social Services, confirmed there are 320 violent West Virginia teens in out-of-state facilities.

Both men agreed that the state legislature should look into establishing an in-state facility to work with these troubled youths.

Ongoing Staffing Shortages

Pack also gave the legislators an update on where things stand with the staffing issues with Child and Adult Protective Services.

During the last regular session, the legislature passed Senate Bill 273 that reallocated Child Protective Services workers based on county population as well as established pay raises and incentives for CPS and Adult Protective Services workers to stay on the job. That included pay raises as well as retention bonuses for employees who stay on the job. The five percent raises take effect at two, four, six and eight years.

Additionally, the starting salary for CPS workers in the Eastern Panhandle was raised to $50,000 to compete with neighboring states.

Pack explained even though the changes are already in place, the agency hasn’t necessarily seen the benefits yet as it takes time to hire, train and prepare new employees to do their job.

Each new employee must complete 240 hours of training, spread out across 11 weeks and then they go through eight weeks of slowly stepped up caseloads covering two to three cases per week before taking on a full caseload. Pack said it will take about a year from the implementation of the new initiatives to see the positive effect.

Vacancies are being filled, however.

Over the summer, Pack said the bureau’s vacancy rate had been reduced from 31 percent in January to 19 percent as of June 2023. Monday he reported that the agency has a 16 percent vacancy rate. Of the agency’s 518 staffers, that leaves approximately 83 openings to be filled.

Paden City Water Works “Do Not Consume” Order Lifted

Paden City has a history of water plant problems with PCE contamination.

The West Virginia Department of Health and Human Resources, Bureau for Public Health has lifted the “do not consume” notice for customers of Paden City Water Works. The notice was issued on August 16, based on three consecutive samples that showed negative detectable levels of tetrachloroethylene (also known as PCE) in the local water supply.

DHHR said in a release that even if PCE levels are below the maximum contaminant level, local customers will receive additional instructions from Paden City Water Works to flush their lines prior to using or consuming the water to remove residual PCE. Those with specific health concerns are advised to consult with a primary care physician or use an alternate source of drinking water.

Paden City Water Works will continue to flush as needed while also collecting weekly samples until the Bureau for Public Health is confident that levels of PCE remain below the MCL.

The elevated PCE was a result of a June mechanical by-pass valve failure which has been corrected. Paden City Mayor Steve Kastigar noted in releases that a June storm prompted a transformer failure at the water plant. He said the air stripper went down because of the transformer failure. As a result, Paden City was running out of water without any ability to fight fires, so the bypass valve was opened, causing the chemical leak.

An administrative order from the Bureau for Public Health was issued to Paden City on August 19 to clarify actions necessary to address the public health issues related to PCE. The order was amended to include additional items to ensure that the treatment was functioning effectively on August 26.

“DHHR’s Bureau for Public Health was pleased to support Paden City and its residents through this issue in coordination with the West Virginia Department of Environmental Protection, U.S. Environmental Protection Agency, the West Virginia Division of Emergency Management, and county and city officials,” said Interim DHHR Secretary Dr. Sherri Young. “The health of residents in Paden City has been a priority for the entire Justice Administration, and we are pleased that the do not consume notice could be lifted.”

Several rounds of sampling were conducted by Paden City and EPA. DHHR coordinated the delivery of testing supplies to Paden City on August 24, for additional water sampling. State resources were also made available to help provide alternative sources of drinking water and support distribution needs.

Paden city has a history of water plant problems with PCE contamination.

To stay updated, customers can reach out to Paden City Hall at 304-337-8581 to sign up for the local Code Red notification system.

Report: Needle Exchange Program Should Lose Certification

An audit requested by a West Virginia mayor who said a needle exchange program had caused an increase of dirty needles in public places has recommended the suspension of the program’s certification.

The Charleston Gazette-Mail reports that a team commissioned by the state Bureau for Public Health submitted a report to Charleston on Friday, saying the Kanawha-Charleston Health Department’s Harm Reduction Syringe Services Program needs to follow a list of recommendations if it’s reinstated. The report emphasized insufficient and inaccurate data collection.

The report was released nearly two months after Charleston Mayor Danny Jones asked for the independent audit and review.

The needle exchange portion of the program has been suspended since late March.

KCHD spokesman John Law says the agency hasn’t been provided a copy of the report.

Tetanus a Public Health Concern After West Virginia Flooding

The two tents set up in a grocery store parking lot in Clendenin were overflowing with people waiting for tetanus vaccines Tuesday afternoon. A shipment of about 1,000 had been promised from out of state, but the FedEx truck holding them was held up in Memphis. Health Right, a free clinic based in Charleston, had about 50 to offer.

“I knew these people were out here waiting and so we do what we do best at free clinics,” said Angie Settle, executive director of Health Right. “We get our boots on the ground, we call people, [and] we tell them what the situation is. We have a good name in the community so people know our hearts are in the right place and they reach out for us.”

So by the time she pulled up to the makeshift hospital around 3 p.m., she had 250 doses with her from four Charleston-based donors – enough to cover that afternoon’s demand.

The vaccinations are part of a public health push to protect the people exposed to floodwater against bacterial disease, particularly tetanus.

Tetanus is a bacterial infection that affects the nervous system. It’s also known as “lockjaw” because it can cause your neck and jaw to lock, making it hard to open your mouth or swallow.

For the past 70 years, tetanus has been steadily declining in the U.S. due to the introduction of vaccines. But it’s still possible to get it through exposure to the bacteria in soil or contaminated water.

Floodwater and residual mud like West Virginia experienced this past week are prime breeding grounds for the bacteria that causes tetanus because “there’s a mix of flood water and sewage that happens,” said commissioner of public health Rahul Gupta.

“The challenge with especially the sewage is the bacteria that can remain alive, and those bacteria can not only remain alive, but can actually grow,” he said.

So if you were a victim of the floods or a first responder or even a reporter who has been mucking around in a cocktail of floodwater, feces and unknown chemicals, you might be at risk.

The very best way to protect yourself against the tetanus bacteria is by using gloves, wearing rubber boots and properly cleaning any cuts. Tetanus bacteria enters the system through contact with the skin.

“So for contact, it really depends if they have any open wounds or abrasions,” said Gupta. “And oftentimes what would happen is you may not always be aware while you are cleaning [that] you have some skin breaks and may have some abrasions that may happen. And you may not feel those, so there can be contact with skin, but especially if it is not intact, and no matter how microscopic, those are bacteria can seep in.”

But vaccines are vitally important too – victims and first responders often did not have all the cleaning supplies they needed in the first few days following the flood.

Angie Settle (left) holds tetanus vaccines at the makeshift hospital in Clendenin.

Fortunately almost everyone is vaccinated for tetanus as children these days. It is one of those vaccines required to enroll in school. But adults need a booster every 10 years to retain their immunity. However, boosters do take a couple weeks before they build full immunity.

Tamra Stall, a family practice doctor in Greenbrier County, said since tetanus has an incubation period of 3 to 21 days, boosters can still help protect people.

“The sooner after exposure they are inoculated, if they have not particularly had it before, the better prevention will be,” she said.

Stall’s office has given more than 1,000 doses of tetanus so far. Staff ran out of the vaccines Monday afternoon. By Monday evening, more than 100 people were on a waiting list. The office received 250 donated doses Tuesday and another 250 Wednesday. The state health department ordered several thousand new doses Monday to address the need for the vaccine across the state.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

Could Drug Testing Save W.Va. Dollars?

The debate over drug testing public assistance recipients was revisited in an interim session Monday. One of the issues on the table is how to make a pilot program work without costing the state additional dollars that are hard to come by.

The Legislative Oversight Commission on Health and Human Resources Accountability met at the Capitol Monday to continue their discussion on a possible pilot program that would drug test public assistance recipients.

“A lot of people are interested in us having the testing program as one tool to decrease drug abuse in the state,” said Delegate Joe Ellington, a Republican from Mercer County and the chairman of the committee, “I, as a practicing obstetrician, see a lot of babies being born to drugs.”

Ellington says this is where many substance abuse problems start. The babies are born addicted to drugs and could either develop behavioral issues, or become more prone to addictive behaviors in the future.

“The current structure we have to help prevention and training and teaching and rehabilitation does not seem to be solving the problem. We’re not opposed to any of those parts. We want to try to enhance those efforts to decrease drug use, but we’re looking at other ways of identifying who is using drugs, so we can get them into programs.”

At the forefront of the discussion Monday were two bills introduced during the 2015 legislative session.

Senate Bill 348 would’ve created a pilot program for drug screening of cash assistance recipients. House Bill 2021 would’ve implemented drug testing for recipients of federal-state and other state assistance dollars.

While both bills had minor differences, what they did have in common was a requirement to drug test based on reasonable suspicion.

At the end of the 2015 session however, both bills were left on the table.

Now lawmakers are reconsidering the issue for the 2016 session.

The committee posed a few questions to the Department of Health and Human Resources and the Bureau for Public Health. They discussed the anticipated cost of target type enforcements on specific populations, the impact on pregnant women who abuse illicit drugs, and what happens to someone after they’ve tested positive for an illegal substance.

Lawmakers were trying to get a sense of how to potentially re-draft legislation that died last year.

But the question still stands – is drug screening of people in state assistance programs constitutional? And would it actually save the state money by implementing these kinds of tests?

Delegate Ellington thinks there’s a good chance.

“Data I received from DHHR previously, a couple years ago, said the average cost for detox was $230,000 a kid,” he said, “That’s a lot of money that could go back to our schools, to teacher pay, to education, to other services, to rehab, and then you look at the lost productivity and the livelihood of those kids and the future to grow up into, and that’s what we’re looking at – the future of our kids in West Virginia altogether.”

However, Sean O’Leary, a policy analyst at the West Virginia Center on Budget and Policy, says the facts show otherwise – many states that have implemented screening programs in the hopes of saving money, haven’t seen the results.

“Policies like this has really two goals, one to curb substance abuse and two to save state money by not paying people who are using drugs, but when you look at what other states have gone through it’s failed to achieve either one of those goals,” O’Leary said.

Thirteen states have passed legislation to drug test or screen public assistance applicants or recipients, and as of July 2015, at least 18 states have proposed legislation requiring some form of drug testing or screening.

West Virginia is one of those eighteen states.

“Under 1 percent of applicants are testing positive when they do, do these tests, so they’re not saving significant amounts of money,” O’Leary explained, “In some cases, they’re actually spending more money administering and collecting these results or these tests, then they are actually saving money from stopping people from using drugs and collecting assistance.”

O’Leary says there’s a misconception that drug abuse is more prevalent among low income people, when actually substance abuse can affect all walks of life.

Delegate Ellington says he knows finding the right legislation won’t be easy.

“The Senate one was looking at three counties as a smaller group to cut down the expense. The other, the House bill, looks at people that have a higher suspicion of drug use, whether they’ve had a previous conviction, or the children were born addicted to drugs, we know that those are positives, so that’s where the higher suspicion is. We want to just target that part. Will you miss some others, yes, but we’re looking at the numbers, we’re trying to decrease the number of testing that has to be done, and look at the number of individuals we can get back off. So there’s no great way to do it, but we’re trying to make an effort to.”

Next month, the committee on Health and Human Resources Accountability will likely begin to draft legislation that could become the new drug testing bill of 2016.